Cardiology curriculum standards (Adult Internal Medicine)

Knowledge guides

LG 12: Scientific foundations of cardiology

Epidemiology, Pathophysiology, and Clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Clinical sciences

Anatomy of the cardiovascular system:
- blood vessels and circulation
  - arterial and venous structure and innervation
  - peripheral vasculature
  - pulmonary vascular system
  - the great vessels
- common congenital abnormalities
  - atrial and ventricular septal defects
  - aortopathies
  - bicuspid aortic valve
  - conduction abnormalities (accessory pathways)
  - patent ductus arteriosus
  - patent foramen ovale
  - Tetralogy of Fallot
  - transposition of the great arteries
- the heart
  - cardiac chambers
  - cardiac innervation
  - cardiac valves
  - conduction pathways
  - coronary arterial system and variants
  - coronary venous system
  - pericardium
Pathophysiology of cardiovascular disease:
- atherosclerosis & cardiac ischaemia
- cardiac valve dysfunction - aortic, mitral, tricuspid, pulmonary
- conduction diseases - atrial fibrillation/flutter, re-entrant tachycardias, ventricular tachycardia, ventricular fibrillation, heart block
- dyslipidaemias
- heart failure
- infective endocarditis
- pericardial diseases - tamponade, constrictive pericarditis, restrictive pericarditis
Physiology of the cardiovascular system:
- arterial blood pressure regulation
  - renin-angiotensin-aldosterone system
  - vascular compliance and vasoactive compounds
  - sympathetic and parasympathetic regulation
- cardiac contractility
  - Frank-Starling mechanism
  - haemodynamic curves
  - myocardial cell biology
  - preload and afterload
  - regulatory systems (renal, nervous)
- congenital
  - shunt calculations
  - Eisenmenger's physiology
- coronary arterial blood flow and regulation
- electrophysiology
  - cellular electrophysiology
  - nervous regulation of heart rate
  - the surface ECG
- hypertension in pregnancy
- lipid metabolism
- microcirculation and interstitial oedema
Principles of pharmacology:
- drug distribution
- drug excretion
- drug metabolism
- mechanisms of major drug classes in cardiology:
  - alpha and beta blockers
  - anti-arrhythmic drug classes
  - anticoagulants
  - antiplatelet agents
  - calcium channel blockers
  - diuretics
  - lipid modifying agents
  - nitrates
  - other heart failure therapies (neprilysin inhibitors, SGLT2 inhibitors, GLP1 agonists, perhexiline)
  - renin-angiotensin system inhibitors
  - thrombolytic therapy
- medications with cardiac complications:
  - cardiotoxic medications
  - QTc prolonging drugs
- PBS prescribing and alternatives
- pharmacodynamics
- pharmacokinetics

Principles of statistics and epidemiology

Basic statistics:
- absolute and relative risk ratios
- likelihood ratios and odds ratios
- null hypothesis and P-values, confidence intervals
- sensitivity, specificity, and predictive values
- statistical tests - chi-square, t-tests, ANOVA, regression analysis
- type I and II errors, power calculations
Clinical research studies:
- ethical principles
- study types
  - case reports
  - observational studies
  - randomised control trials
  - registry analyses
  - systematic reviews and meta analysis
Levels of evidence and classes of recommendations
Population risk determination of cardiovascular disease:
- biomarker development
- community/policy prevention measures
- risk scoring systems

Non-invasive investigations

Ambulatory blood pressure monitoring
Ankle-brachial index
Arterial and venous doppler studies
Basic cardiac laboratory investigations (BNP/NT-proBNP, CK-MB, fasting lipid profiles, high sensitivity CRP, troponin)
Cardiac MRI (CMR)
CT coronary angiography (CTCA) and coronary artery calcium score (CACS)
Echocardiography and stress echocardiography
Electrocardiography
Exercise stress testing Holter monitoring
Myocardial perfusion scans
Positron emission studies

Procedures and invasive investigations

Alcohol septal ablation
Cardiac biopsy
Cardiac resynchronisation therapy
Cardiac transplantation
Coronary angiography and percutaneous coronary intervention
Defibrillator implantation
Direct current cardioversion
Electrophysiology studies and ablation
Mechanical circulatory support (e.g. extracorporeal membrane oxygenation, intra-aortic balloon pump insertion, left ventricular assist devices)
Pacemaker implantation
Pericardiocentesis
Right heart catheterisation
Temporary pacing wire insertion
Trans-catheter valve interventions
Transoesophageal echocardiography